Medical instrument

ABSTRACT

A medical device capable of improving operativity and safety when a body surface part and an internal tissue are put in a suture is provided. The medical device used to put a body surface part and an internal tissue in a suture, includes a main body ( 2 ), a suture insertion needle ( 3 ) which is supported by the main body ( 2 ), and into which the suture can be inserted, and a suture grasping needle ( 4 ) which is provided to be proximate to the suture insertion needle ( 3 ), and into which a suture traction tool can be inserted. The suture insertion needle ( 3 ) and the suture grasping needle ( 4 ) are detachably attached to the main body ( 2 ) by an attachment and detachment unit.

FIELD OF THE INVENTION

The present invention relates to a medical device.

DESCRIPTION OF THE RELATED ART

To feed a patient who cannot take nutrients from his or her mouth, threefeeding methods have been adopted: intravenous feeding, gastric feedingusing a tube inserted from a nose into a stomach, and enteral feedingfrom grastric fistula.

In recent years, by the growth of enteral nutritional products andapplication methods therefor, enteral nutrition management by means ofpercutaneous endoscopic gastrostomy (PEG) has been frequently conducted.According to the PEG, a gastrostomy is made with a less complicatedoperation than that by surgical gastronomy, so the PEG causes smallinvasion and costs far less than the surgical gastronomy. Thus, the PEGis considered standard of the gastrostomy in the Western countries.

According to the PEG, a through hole that penetrates an abdominal walland a stomach wall of a patient is formed prior to the gastrostomy.Prior to formation of the through hole, the stomach wall which tends tomove is temporarily fixed. Normally, therefore, the abdominal wall andthe stomach wall are put in a suture.

As medical devices for such suturing operation, a medical deviceconsisting of, for example, a suture insertion needle, a suture graspingneedle arranged in parallel to the suture insertion needle, a styletslidably inserted into the suture grasping needle, and a fixing memberthat fixes the suture insertion needle and the suture grasping needle ontheir respective base ends, and configured so that the suture is graspedby the stylet is disclosed (Patent Literature 1).

The medical device disclosed in the Patent Literature 1 includes (a) thehollow suture insertion needle having an internal passage into which asuture is inserted, (b) the hollow suture grasping needle arranged inparallel therto and used to grasp the suture, (c) the stylet slidablyinserted into the suture grasping needle, and (d) the fixing memberfixing the suture insertion needle and the suture grasping needle ontheir respective base ends. This stylet includes an annular member whichconsists of an elastic material, which can be stored in the internalpassage of the suture grasping needle, and which is provided on a tipend of the stylet. The annular member is configured to extend toward thesuture insertion needle while protruding from the tip end of the suturegrasping needle so that a central axis of the suture insertion needle oran extension thereof is passed through an inside of the annular member.

According to the Patent Literature 1, this medical device is used asfollows. First, a living body is punctured by the suture insertionneedle and the suture grasping needle. The stylet is inserted into thesuture grasping needle from a rear end thereof, and the annular memberprotrudes from the tip end of the suture grasping needle. The suture isinserted into the suture insertion needle from a rear end thereof. As aresult, the suture is exposed from the tip end of the suture insertionneedle. In this state, the stylet within the suture grasping needle ismoved backward, whereby the suture is grasped by the annular member.Finally, the suture insertion needle, the suture grasping needle, andthe stylet are integrally moved backward from the living body. One endof the suture is thereby pulled out from the suture insertion needleside and the other end thereof is pulled out from the suture graspingneedle.

However, when the medical device disclosed in the Patent Literature 1 isused, the suture is captured by the annular member on the tip end of thesuture grasping needle, which tip end is sharp. If the suture contactswith the suture grasping needle by excessively strong force when thestylet is moved backward, the suture may possibly be cut off.

Further, with the medical device disclosed in the Patent Literature 1,the two puncture needles should be used simultaneously to puncture theliving body. Due to this, more advanced expertise is required ascompared with operation of puncturing the living body with one needle.

To ensure fixing the abdominal wall to the stomach wall using themedical device, it is necessary to perform the same suturing operationtwice, which is disadvantageously a burden on the patient.

To prevent this disadvantage, a suture instrument for a living body isdisclosed in Patent Literature 2. This living body suture instrumentincludes (a) a hollow fixing needle including an internal passage intowhich a suture is inserted and having a sharp tip end, (b) a hollowouter cylinder arranged in parallel to the hollow fixing needle,including an internal passage into which the suture is inserted, andhaving a non-sharp tip end, (c) a movable needle which can beselectively pulled out from the internal passage of the outer cylinderand having a sharp tip end, and a suture traction tool, and (d) a holderholding the fixing needle and the outer cylinder in parallel at one oftheir positions, respectively.

According to the Patent Literature 2, this living body suture instrumentsolves the above-stated disadvantage. First, a living body is puncturedby the fixing needle and the movable needle inserted into the outercylinder. The movable needle is then pulled out from the outer cylinder,the suture traction tool is inserted into the outer cylinder from a rearend thereof, and a snare protrudes from a tip end of the outer cylinder.The suture is inserted into the fixing needle from a rear end thereof.As a result, the suture is exposed from a tip end of the fixing needle.In this state, the suture traction tool within the outer cylinder ismoved backward, whereby the suture is pulled out from the outer cylinderto the outside of the living body through the non-sharp tip end whilethe suture is grasped by the snare. At this time, it is not necessaryfor the suture to pass through the sharp portion, so that the suture isprevented from being cut off.

However, according to the living body suture instrument disclosed in thePatent Literature 2, since the suture traction tool is passed through aninside of the outer cylinder while grasping the suture, a diameter ofthe outer cylinder becomes disadvantageously large. Besides, even if themovable needle is sharp, the puncture performance may possibly bedeteriorated by influence of a difference in height between the movableneedle and the outer cylinder.

Moreover, according to the living body suture instrument disclosed inthe Patent Literature 2, it is required to simultaneously operate thetwo needles although they are not used to simultaneously puncture theliving body. Due to this, more advanced expertise is required ascompared with operation of puncturing the living body with one needle.

Also, the suture insertion needle and the suture grasping needle of themedical device in the patent literature 1 and the fixing needle of thesuture instrument for the living body in the patent literature 2 arehollow needle, so the puncture performances of the needles have tend todeteriorate relative to the case with a non-hollow needle.

Patent Literature 1: Japanese Patent Application Laid-Open No. H4-226643

Patent Literature 2: Japanese Patent Application Laid-Open No.2003-225240

SUMMARY OF THE INVENTION

The present invention has been achieved in view of these circumstances.It is an object of the present invention to provide a medical devicecapable of improving operativity and safety when a body surface part andan internal tissue are put in a suture.

According to the present invention, there is provided a medical devicecomprising:

(a) a suture insertion needle that is a hollow puncture needle includinga sharp tip end, the tip end being non-hollow, that includes a lateralhole near the tip end, and that is used by inserting a suture into ahollow portion of the suture insertion needle;

(b) a suture grasping needle that is a hollow puncture needle arrangedsideways of the suture insertion needle substantially in parallel to thesuture insertion needle and including a sharp tip end, the tip end beingnon-hollow, that includes a lateral hole near the tip end, and that isused by inserting the suture into a hollow portion of the suturegrasping needle;

(c) a suture traction tool slidably inserted into the hollow portion ofthe suture grasping needle;

(d) a fixing member for relatively determining a tip end position of thesuture insertion needle and a tip end position of the suture graspingneedle; and

(e) an abutment member that supports the suture insertion needle and thesuture grasping needle, and that abuts on a suture target.

In addition, according to the present invention, there is provided amedical device used to put a body surface part and an internal tissue ina suture, comprising: a main body; a suture insertion needle which issupported by the main body, and into which the suture can be inserted;and a suture grasping needle which is provided to be proximate to thesuture insertion needle, and into which a suture traction tool can beinserted, wherein the suture grasping needle includes a sharp tip endand an opening provided in proximity to a base end side relative to thetip end, and is configured so that the suture traction tool can bewithdrawn from the opening to an outside of the suture grasping needle.

In the medical device according to the present invention, the tip endsof the respective puncture needles are non-hollow, so that the punctureperformances of the needles can be improved. The hollow portion of eachpuncture needle communicates with the outside thereof through thelateral hole or the opening near the tip end. Due to this, it ispossible to ensure that the suture and the suture traction tool arepulled out from the lateral hole to a predetermined direction. Thus,good operativity and safe suturing operation can be ensured. Inaddition, since the suture insertion needle and the suture graspingneedle are supported by the abutment member and the abutment memberabuts on suture targets such as the body surface part, the suturingoperation can be ensured.

In the medical device according to the present invention, the suturetraction tool may include a snare having a tip end formed out of anelastically deformable material, which extend so that an extension ofthe suture insertion needle passes through an inside of the snare in afree state, and can be stored in the hollow portion of the suturegrasping needle in an elastically deformed state. By configuring so, thesuture can be surely grasped. The suturing operation can be thereforeensured.

In the medical device according to the present invention, the abutmentmember may support the suture insertion needle and the suture graspingneedle substantially parallel to each other. By configuring so, thesuturing operation can be stably performed.

In the medical device according to the present invention, the fixingmember may be provided at the suture grasping needle, and configured tobe able to determine the tip end position of the suture insertion needlerelative to the tip end position of the suture grasping needle, to anarbitrary position. By configuring so, the operativity during thesuturing operation can be further improved.

In the medical device according to the present invention, a notchconfigured to remove the suture from the abutment member and the fixingmember may be provided at each of the abutment member and the fixingmember. By configuring so, while the suture grasping needle puncturesthe body, it is possible to ensure that the suture is removed from theabutment member and the fixing member. It is, therefore, possible toensure performing the suturing by simple operation.

In the medical device according to the present invention, an edge of thelateral hole of the suture insertion needle and an edge of the lateralhole of the suture grasping needle may be chamfered to have a C-shapedsurface or an R-shaped surface. This make it possible to suppressbreaking of the suture. It is, therefore, possible to further ensure thesuturing operation.

In the medical device according to the present invention, at least oneof the suture insertion needle and the suture grasping needle can bedetachably supported by the abutment member. By configuring so, thesuturing operation can be further simplified The medical deviceaccording to the present invention may further comprise a plurality ofthe suture insertion needles, and the suture grasping needle may beconfigured to be provided to be proximate to each of the plurality ofsuture insertion needles. Thus, the operation of removing the sutureinsertion needle and the operation of rotating the abutment member whensuturing a plurality of sites are possible to be not required. It is,therefore, possible to further ensure that the plurality of sites arestably sutured by the simple operation.

According to the present invention, there is provided a medical deviceused to put a body surface part and an internal tissue in a suture,comprising: a main body; a suture insertion needle which is supported bythe main body, and into which the suture can be inserted; and a suturegrasping needle which is provided to be proximate to the sutureinsertion needle, and into which a suture traction tool can be inserted,whrein at least one of the suture insertion needle and the suturegrasping needle is detachably attached to the main body.

In the medical device according to the present invention, at least oneof the suture insertion needle and the suture grasping needle isdetachably attached to the main body. It is, therefore, possible toensure good operativity and stable suturing operation.

In the medical device according to the present invention, the main bodymay include a fixing member that fixes one of a tip end of the sutureinsertion needle and a tip end of the suture grasping needle to apredetermined position; and a support member that supports the fixingmember. By configuring so, stable suturing operation can be ensured.

In the medical device according to the present invention, the main bodymay further include an abutment member that is provided on a tip endside of the support member, that abuts on the body surface part, andthat supports the suture insertion needle and the suture graspingneedle. By configuring so, the medical device can abut on the bodysurface part at the abutment member thereof during the suturingoperation. Thus, it is possible to further ensure the stable suturingoperation. In the medical device according to the present invention, thesupport member may be configured to support the fixing member and theabutment member. By configuring so, the suture insertion needle and thesuture grasping needle can be supported by the support member throughthe abutment member. It is, therefore, possible to further ensuresupporting these puncture needles and further improve the stability ofthe medical device during use.

In the medical device according to the present invention, the suturegrasping needle may be configured so that a guide wire can be alsoinserted into the suture grasping needle. By configuring so, anapplicable range of the medical device can be enlarged. For example, ifa guide wire is used, it is possible to appropriately determine acatheter insertion route and to insert a catheter safely and surely.Further, if the guide wire is used, it is possible to realize insertionof the guidewire simultaneously with suturing the body surface part andthe internal tissue. Due to this, it is possible to appropriatelydetermine the catheter insertion route after the suturing operation andto insert the catheter safely and surely. Besides, the number of timesby which the puncture needles puncture the body surface and the internaltissue until the catheter is inserted can be reduced, the invasion ofthe needles into the patient occurs quite infrequently, and the patientis less burdened. It is, therefore, possible to return the patient toordinary life at earlier time and to reduce medical cost of the patient.

In the medical device according to the present invention, an outsidediameter of the guide wire may be equal to or larger than 0.1 mm andequal to or smaller than 0.8 mm.

In the medical device according to the present invention, the fixingmember may include a notch that makes one of the suture insertion needleand the suture grasping needle detachable from the main body. Byconfiguring so, it is possible to ensure attachment and detachment ofthe suture insertion needle or the suture grasping needle.

In the medical device according to the present invention, the abutmentmember may include a notch that makes one of the suture insertion needleand the suture grasping needle detachable from the main body. Byconfiguring so, the attachment and detachment of the suture insertionneedle and the suture grasping needle can be performed simply andsurely.

In the medical device according to the present invention, the sutureinsertion needle and the suture grasping needle may be configured to beable to puncture independently of each other. By configuring so, the twopuncture needles can be operated individually without puncturingsimultaneously by the two puncture needles or without simultaneouslyoperating the two puncture needles. Therefore, good operativity and safeoperation can be ensured. In addition, the stress of the patient can belessened and operation time can be shortened. It is, therefore, possibleto improve the operativity and safety when suturing the body surfacepart and the internal tissue by the suture.

In the medical device according to the present invention, while thesuture insertion needle and the suture grasping needle puncture and themain body abuts on the body surface part, the suture insertion needlecan be independently removed. By configuring so, the suture insertionneedle can be removed while grasping the suture by the suture graspingneedle. It is, therefore, possible to suture a plurality of sites by aseries of operations.

In the medical device according to the present invention, the main bodymay be rotatable about the suture grasping needle used as a rotationalaxis. By configuring so, it is possible to ensure suturing a pluralityof sites.

The medical device according to the present invention includes aplurality of the suture insertion needles, and the suture graspingneedle can be provided to be proximate to each of the plurality ofsuture insertion needles. By configuring so, the operation of removingthe suture insertion needle alone and the operation of rotating the mainbody when suturing a plurality of sites are possible to be not required.It is, therefore, possible to further ensure that the plurality of sitesis sutured by the simple operation.

Arbitrary combinations of these respective constituent elements andchange of the expression of the present invention between a method andan apparatus or the like are also effective as the modes of the presentinvention.

For example, according to the present invention, there is provided asuturing method using a medical device, the method comprising the stepsof:

(i) penetrating the suture grasping needle into the body surface partand the internal tissue;

(ii) inserting the suture traction tool into the hollow portion of thesuture grasping needle, and withdrawing the suture traction tool outsideof the suture grasping needle;

(iii) penetrating the suture insertion needle into the body surface partand the internal tissue;

(iv) inserting the suture into the hollow portion of the sutureinsertion needle, and puling out the suture to the outside of the sutureinsertion needle;

(v) grasping the pulled-out suture by the suture traction tool withdrawnto the outside of the suture grasping needle;

(vi) pulling the suture traction tool while the tool grasps the suture,attracting the suture to the suture grasping needle, and holding thesuture near the suture grasping needle; and

(vii) while holding the suture near the suture grasping needle, pullingout the suture as well as the suture grasping needle to the outside ofthe body surface part and the internal tissue.

According to the suturing method of the present invention, it ispossible to ensure suturing the body surface part and the internaltissue by the simple operation.

In this suturing method, in the step (vii), after withdrawing the suturetraction tool to the outside, the suture grasping needle can be pulledout.

The suturing method according to the present invention may include astep of, after the step of holding the suture near the suture graspingneedle, pulling out the suture insertion needle and then rotating themain body about the suture grasping needle used as an axis while thesuture grasping needle punctures the body surface part and the internaltissue. In addition, the suturing method according to the presentinvention may include a step of, after the step of rotating the mainbody, penetrating again the suture insertion needle into the bodysurface part and the internal tissue.

By doing so, the suture insertion needle can puncture a plurality ofconcentric sites with the suture grasping needle used as the rotationaxis. It is, therefore, possible to ensure suturing a plurality ofsites. It is also possible to reduce the number of times by which thepuncture needles puncture the target sites since the suturing of aplurality of planned suture sites separate from one another until thecatheter is inserted.

BRIEF DESCRIPTION OF THE DRAWINGS

The above object, the other objects, features and advantages of theinvention will be readily apparent from the following preferredembodiments and accompanying drawings.

FIG. 1 is a sectional front view that depicts a medical device accordingto one embodiment of the present invention.

FIG. 2 a is a sectional front view that depicts a configuration of asuture grasping needle of the medical device according to theembodiment.

FIG. 2 b is a sectional view that depicts a configuration of a suturetraction tool of the medical device according to the embodiment.

FIG. 2 c is a sectional front view that depicts a configuration of acombination of FIGS. 2 a and 2 b.

FIG. 3 is a sectional front view of a suture insertion needle of themedical device according to the embodiment.

FIG. 4 is a sectional front view that depicts a tip end of the suturegrasping needle of the medical device according to the embodiment.

FIG. 5 depicts a front view and a plan view of an abutment member of themedical device according to the embodiment.

FIG. 6 is an explanatory view for procedures for using the medicaldevice according to the embodiment.

FIG. 7 is a sectional front view that depicts a step 1 of a method forusing the medical device according to the embodiment shown in FIG. 6.

FIG. 8 is a sectional front view that depicts a step 2 of the method forusing the medical device according to the embodiment shown in FIG. 6.

FIG. 9 is a sectional front view that depicts a step 3 of the method forusing the medical device according to the embodiment shown in FIG. 6.

FIG. 10 is a sectional front view that depicts a step 4 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 11 is a sectional front view that depicts a step 5 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 12 is a sectional front view that depicts a step 6 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 13 is a sectional front view that depicts a step 7 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 14 is a sectional front view that depicts a step 8 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 15 is a sectional front view that depicts a step 9 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 16 is a sectional front view that depicts a step 10 of the methodfor using the medical device according to the embodiment shown in FIG.6.

FIG. 17 is a perspective view that depicts a configuration of a medicaldevice according to an embodiment of the present invention.

FIG. 18 is a front view that depicts a configuration of a main body ofthe medical device according to the embodiment.

FIG. 19 depicts a front view and a sectional view of a suture insertionneedle of the medical device according to the embodiment.

FIG. 20 depicts a front view and a sectional view of a suture graspingneedle of the medical device according to the embodiment.

FIG. 21 is a front view that depicts a suture traction tool of themedical device according to the embodiment.

FIG. 22 is a sectional front view that depicts a state in which anabutment member of the medical device according to the embodiment abutson an abdominal wall and in which the abdominal wall is puncturedperpendicularly by the suture grasping needle.

FIG. 23 is a sectional front view that depicts a state in which thesuture traction tool of the medical device according to the embodimentis inserted into the suture grasping needle.

FIG. 24 is a sectional front view that depicts a state in which thesuture insertion needle is inserted into an inside of an annular portionof the suture traction tool of the medical device according to theembodiment.

FIG. 25 is a sectional front view that depicts a state in which thesuture protrudes from a tip end of the suture insertion needle of themedical device according to the embodiment.

FIG. 26 is a sectional front view that depicts a state in which thesuture insertion needle of the medical device according to theembodiment is pulled out.

FIG. 27 is a sectional front view that depicts a state in which the mainbody is rotated by about 180 degrees about the suture insertion needleas a rotational axis of the medical device according to the embodiment.

FIG. 28 is a sectional front view that depicts a state in which thesuture insertion needle of the medical device according to theembodiment punctures again the body and in which the suture is insertedinto the needle.

FIG. 29 is a sectional front view that depicts a state in which thesuture traction tool of the medical device according to the embodimentis withdrawn and the suture is grasped by the annular portion.

FIG. 30 is a sectional front view that depicts a state of inserting aguide wire of the medical device according to the embodiment.

FIG. 31 is a sectional front view that depicts a state in which suturesinserted from two positions at which the suture insertion needle of themedical device according to the embodiment punctures pass from theabdominal wall into the stomach wall, and protrudes from positions atwhich the suture grasping needle punctures the body.

FIG. 32 is a perspective view that depicts a configuration of a medicaldevice according to an embodiment of the present invention.

FIG. 33 is a front view that depicts a configuration of a main body ofthe medical device according to the embodiment.

FIG. 34 depicts a front view and a sectional view of a suture insertionneedle of the medical device according to the embodiment.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present invention will be described hereinafter indetail with reference to the drawings. A medical device describedhereinafter is a suture fixing tool for medical treatments used to put abody surface part and an internal tissue in a suture. This medicalsuture fixing tool is specifically used to fix an abdominal wall to astomach wall for facilitating insertion of a catheter in percutaneousendoscopic gastrostomy conducted to, for example, supply nutritionalsupplements or discharge a body fluid. In FIGS. 1 to 5 and FIGS. 7 to34, an upside of each sheet is a base end (rear end) side of the sutureand a downside of each sheet is a tip end side of the suture.

FIRST EMBODIMENT

FIG. 1 is a sectional view that depicts a configuration of a medicaldevice according to the present embodiment. The medical device shown inFIG. 1 includes a suture grasping needle 701, a guide material 706, afixing member 708, a suture traction tool 710, a suture insertion needle715, and an abutment member 722. This medical device can be used as, forexample, an abdominal wall-to-stomach wall fixing tool.

FIGS. 2 a to 2 c depict a configuration of the suture grasping needle701 and those of peripheral members of the puncture needle 701. FIG. 2 ais a sectional view that depicts a state in which the suture graspingneedle 701 is combined with the guide material 706 and the fixing member708. FIG. 2 b is a sectional view that depicts a configuration of thesuture traction tool 710. FIG. 2 c is a sectional view that depicts astate of combining FIGS. 2 a and 2 b.

As shown in FIGS. 2 a to 2 c, a rod 711 and a snare 712 of the suturetraction tool 710 are configured to be able to be stored in a hollowportion 703 of the suture grasping needle 701. By allowing a slidematerial 713 to slide along the guide material 706, the suture tractiontool 710 is slidably moved within the hollow portion 703, and the snare712 provided on a tip end of the suture traction tool 710 can be pulledout from a lateral hole 704 of the suture grasping needle 701 to anoutside of the hollow portion 703.

FIG. 4 is an enlarged sectional view of a tip end of the suture graspingneedle 701. The suture grasping needle 701 is a hollow needle memberconsisting of metal and includes a sharp tip end 702. Because of thesharp tip end 702, the suture grasping needle 701 can easily puncturethe skin. In addition, the suture grasping needle 701 is configured sothat the hollow portion 703 formed inside does not penetrate the tip end702. The hollow portion 703 is structured to communicate with theoutside through the lateral hole 704 provided near the tip end 702. Thesuture traction tool 710 can be slidably moved within the hollow portion703. Specifically, an outside diameter of the suture grasping needle 701can be set, for example, equal to or larger than 12G and equal to orsmaller than 22G, preferably equal to or larger than 19G and equal to orsmaller than 21G. If a guide wire is inserted into the hollow portion703, the outside diameter of the suture grasping needle 701 can be set,for example, equal to or larger than 16G and equal to or smaller than18G. By so setting, it is possible to easily insert the suture tractiontool and the guide wire simultaneously into the suture grasping needle701, and appropriately insert the guide wire into a living body togetherwith the suture.

An entire length of the suture grasping needle 701 is not limited to aspecific length; however, it can be set, for example, equal to or largerthan 20 mm and equal to or smaller than 200 mm, preferably equal to orlarger than 80 mm and equal to or smaller than 100 mm. If the entirelength is too small, the suture grasping needle 701 may possibly beburied in an abdominal wall of a patient. If too large, operativity ofthe medical device may possibly be deteriorated.

In the suture grasping needle 701, a portion that may possibly contactwith the suture during a suturing operation may be configured to benon-sharp. As will be described later, the lateral hole 704, inparticular, possibly in contact with the suture when the suture isgrasped by the suture traction tool 710, attracted and held by thesuture grasping needle 701 is configured to be non-sharp. Specifically,an edge of the lateral hole 704 can be chamfered to have a C-shapedsurface or an R-shaped surface.

Further, the suture grasping needle 701 can be configured so that nodifference in height is present in the hollow portion 703 continuousfrom a rear end of the suture grasping needle 701 to the lateral hole704. By doing so, when the suture traction tool 710 is slidably movedwithin the hollow portion 703, the suture traction tool 710 can smoothlyslide without catching the snare 712 in the tractor 710. Specifically,in a portion of the hollow portion 703 continuous to the lateral hole704, the hollow portion 703 can be configured so that a central axis ofthe lateral hole 704 is inclined from that of the suture grasping needle701 at 120 to 150 degrees.

The guide material 706 is attached to the rear end of the suturegrasping needle 701 in a direction opposite to an extension direction ofthe suture grasping needle 701. The guide material 706 is slidablyfitted into the slide material 713 attached to a rear end of the suturetraction tool 710 to be described later. A shoulder surface 707 of theguide material 706 abuts on a shoulder surface 714 of the slide material713, whereby the suture traction tool 710 is slidably moved within thehollow portion 703 of the suture grasping needle 701, and the guidematerial 706 functions to indicate that the suture traction tool 710reaches a forward limit.

Further, this guide material 706 is fitted into the slide material 713only in one direction. Due to this, if the suture traction tool 710 isslidably moved within the hollow portion 703 of the suture graspingneedle 701 and reaches the forward limit, it is possible to ensure thatthe snare 712 of the suture traction tool 710 is widened in a directionof the suture insertion needle 715.

The fixing member 708 is attached to the rear end of the suture graspingneedle 701. The fixing member 708 is configured so that a shouldersurface 709 thereof is fitted into that of a stopper (not shown) of thesuture insertion needle 715, to be described later, only in a certaindirection to prevent the fixing member 708 from being relatively rotatedto the puncture needle 715. By doing so, it is possible to ensure that alateral hole (not shown) of the suture insertion needle 715 is arrangedon the suture grasping needle 701 side. In addition, by so fitting, atip end (not shown) of the suture insertion needle 715 can be positionedonly at one position forward of that of the tip end 702 of the suturegrasping needle 701.

The suture traction tool 710 includes the rod 711, the snare 712attached to a tip end of the rod 711, and the slide material 713attached to a rear end thereof. The rod 711 can be formed out of metal.The snare 712 is formed out of an elastically deformable material.

The snare 712 is annular in a free state. If stored in the hollowportion 703 of the suture grasping needle 701, the snare 712 is linearlyand elastically deformed. As a result, the snare 712 is shaped into anannular body when being forced out from the lateral hole 704 to theoutside of the suture grasping needle 701. The snare 712 can, therefore,easily capture a portion of the suture (not shown) exposed from the tipend of the suture insertion needle 715.

As stated above, the slide material 713 attached to the rear end of thesuture traction tool 710 is slidably fitted into the guide material 706attached to the rear end of the suture grasping needle 701 to abut theshoulder surface 714 of the slide material 713 on the shoulder surface707 of the guide material 706. Thus, the slide material 713 functions toindicate that the suture traction tool 710 reaches the forward limitwithin the hollow portion 703 of the suture grasping needle 701.

FIG. 3 is a sectional view that depicts a configuration of the sutureinsertion needle 715. A shape of the suture insertion needle 715 can bedesigned similar to that of the suture grasping needle 701 shown in FIG.4. The suture insertion needle 715 is a hollow needle consisting ofmetal and includes a sharp tip end 716. Because of the sharp tip end716, the suture insertion needle 715 can easily puncture the skin. Inaddition, a hollow portion 717 formed inside the suture insertion needle715 is configured not to penetrate the tip end 716. The hollow portion717 is structured to communicate with the outside through the lateralhole 718 provided near the tip end 716. The suture can be inserted intothis hollow portion 717.

Specifically, an outside diameter of the suture insertion needle 715 canbe set, for example, equal to or larger than 15G and equal to or smallerthan 25G, preferably equal to or larger than 19G and equal to or smallerthan 21G. By so setting, it is possible to reduce a puncture resistanceof the suture insertion needle 715 and the suture insertion needle 15can easily puncture the skin.

An entire length of the suture insertion needle 715 is not limited to aspecific length; however, it can be set, for example, equal to or largerthan 20 mm and equal to or smaller than 200 mm, preferably equal to orlarger than 80 mm and equal to or smaller than 100 mm. If the entirelength is too small, the suture insertion needle 715 may possibly beburied in the abdominal wall of the patient. If too large, theoperativity of the medical device may possibly be deteriorated.

In the suture insertion needle 715, a portion that may possibly contactwith the suture can be configured to be non-sharp. The lateral hole 718of the suture insertion needle 715, in particular, possibly in contactwith the suture when the suture is grasped by the suture traction tool710 and attracted to the suture grasping needle 701 is configured to benon-sharp. Specifically, an edge of the lateral hole 718 can bechamfered to have a C-shaped surface or an R-shaped surface.

Further, it is preferable that no difference in height is present in thehollow portion 717 continuous from the rear end of the suture insertionneedle 715 to the lateral hole 718 so that the suture can be smoothlyinserted into the hollow portion 717. Specifically, in a portion of thehollow portion 717 continuous to the lateral hole 718, the hollowportion 717 can be configured so that a central axis of the lateral hole718 is inclined from that of the suture insertion needle 715 at 120 to150 degrees.

A stopper 719 is attached to the rear end of the suture insertion needle715. As stated, a shoulder surface 720 of this stopper 719 is fittedinto the shoulder surface 709 of the fixing member 708 attached to therear end of the suture grasping needle 701 only in one direction so asto prevent from being relatively rotated. It is thereby possible toensure that the lateral hole 718 of the suture insertion needle 715 isoriented to the direction of the suture grasping needle 701. By thusfitting, the tip end 716 of the suture insertion needle 715 can bepositioned only at one position forward of that of the tip end 702 ofthe suture grasping needle 701.

A tapered hole 721 for inserting the suture is formed in the stopper719. A diameter of a large-diameter side of this tapered hole 721 islarger than an inside diameter of the suture insertion needle 715. Thediameter of the tapered hole 721 is smaller as nearer to the sutureinsertion needle 715, and a diameter of a small-diameter side of thetapered hole 721 is substantially equal to the inside diameter of thesuture insertion needle 715. The configuration in which no difference inheight is present between this tapered hole 721 and the inside of thesuture insertion needle 715 can be thereby provided. Due to this, thesuture (not shown) can be smoothly inserted into the suture insertionneedle 715 from the rear end thereof.

FIG. 5 depicts a front view and a plan view of the abutment member 722.The abutment member 722 keeps a distance between the suture graspingneedle 701 and the suture insertion needle 715 constant and holds theneedles 701 and 715 in parallel to each other. As will be describedlater, the abutment member 722 abuts on suture targets such as a bodysurface part during the suturing operation. The medical device can be,therefore, held on each suture target during the suturing operation. Thesuture targets can be, therefore, surely put in the suture. The suturegrasping needle 701 and the suture insertion needle 715 can be slidablymoved within the abutment member 722 independently of each other.

A notch 723 is formed on a side of the abutment member 722 on which sidethe suture insertion needle 715 is located. A width of a portion of thisnotch 723 which portion contacts with the suture insertion needle 715 isset, for example, about φ0.25 to 0.5 mm. By so setting, while the sutureinsertion needle 715 is removed from the abutment member 722, the suture705 from the notch 723 can be removed and the abutment member 722 can beeasily rotated about the suture grasping needle 701. In addition, bythus configuring, as will be described later, a plurality of puncturepositions of the suture insertion needle 715 can be arrangedconcentrically about the puncture position of the suture grasping needle701 set as one end of the planned suture site.

As a material for this abutment member 722, a high transparencysynthetic resin material, for example, can be used. The abutment member722 is disposed on a site in which a small incision is made in theabdomen with a knife by the method for using the medical device to bedescribed later. If the material for the abutment member 722 is atransparent material, it is possible to further ensure performing thesuturing operation.

As can be understood, according to this embodiment, the suture insertionneedle 715 and the suture grasping needle 701 each exhibiting a highpuncture performance, and the abutment member 722 capable of improvinguser-friendliness without simultaneously allowing these puncture needles715 and 701 to puncture the target site can be provided. In addition,the medical device capable of concentrically arranging a plurality ofsuture sites can be stably provided. It is, therefore, possible toimprove the performance of the medical device for suturing the abdominalwall and the stomach wall by the suture in the percutaneous endoscopicgastrostomy.

The practical method for using the medical device according to thepresent invention will next be described so as to clarify advantages ofthe present invention.

FIG. 6 is a flowchart of the method for using the medical deviceaccording to this embodiment. FIGS. 7 to 16 are explanatory views forrespective procedures in steps 1 to 10 shown in FIG. 6.

The medical device according to this embodiment is used to suture aplurality of planned suture sites separated from one another in theliving body by a suture. Before using the medical device according tothis embodiment, an endoscope is inserted into the stomach of thepatient to sufficiently supply the air thereto, and an inner side of theabdomen is closely attached to an outer wall of the stomach. Next, aposition of the stomach is confirmed by a transparent light from theendoscope, and the abdominal skin is disinfected and anesthetizedlocally. A small incision is made in the position of the stomach by theknife.

In a step 1, the abutment member 722 according to the present inventionis disposed on the small-incision site of an abdominal wall 100 (FIG.7).

In a step 2, the suture grasping needle 701 according to the presentinvention punctures the abdominal wall 100 and a stomach wall 101 of thepatient perpendicularly through the abutment member 722 (FIG. 8). Atthis time, the suture traction tool 710 is already stored in the hollowportion 703 of the suture grasping needle 701, and the snare 712 islinearly and elastically deformed.

Next, in a step 3, the shoulder surface 714 of the slide member 713attached to the rear end of the suture grasping needle 701 is allowed toslide until abutting on the shoulder surface 707 of the guide material706 of the suture grasping needle 701 (FIG. 9). By doing so, the snare712 of the suture traction tool 710 protrudes from the lateral hole 704in a direction in which the suture grasping needle 701 can puncture thetarget site, thereby forming the snare 712 into an annular shape in afree state.

Then, in a step 4, similarly to the suture grasping needle 701, thesuture insertion needle 715 punctures the abdominal wall 100 and thestomach wall 101 of the patient perpendicularly through the abutmentmember 722 (FIG. 10). At this time, it is confirmed by the endoscopethat the suture insertion needle 715 is passed through an inside of theannular snare 712 of the suture traction tool 710.

In this embodiment, the suture grasping needle 701 and the sutureinsertion needle 715 are puncture needles each having the non-hollowsharp tip end. Due to this, as compared with the use of a punctureneedle having a difference in height such as a hollow needle, a cannula,or an outer cylinder, the high puncture performance is ensured and theliving body can be easily punctured. Further, in this embodiment, thesuture grasping needle 701 and the suture insertion needle 715 areoperated individually. Due to this, as compared with the instance inwhich the living body is punctured simultaneously by the suture graspingneedle 701 and the suture insertion needle 715 or the instance in whichthe suture grasping needle 701 and the suture insertion needle 715 aresimultaneously operated, the medical device does not require strongforce, experience, and expertise and can easily fulfill the function ofpuncturing the living body.

In a step 5, the suture 705 is inserted into the suture insertion needle715 from the rear end thereof, and the end of the suture 705 is exposedfrom the lateral hole 718 of the suture insertion needle 715 (FIG. 11).In this state, since the suture insertion needle 715 itself is passedthrough the inside of the snare 712 formed into the annular shape of thesuture traction tool 710, the suture 705 pulled out from the sutureinsertion needle 715 is also passed through the inside of the snare 712.

In a step 6, only the suture insertion needle 715 is pulled out from theliving body and the abutment member 722 while leaving the suture 705 asit is (FIG. 12). As a result, the suture 705 is passed through theinside of the snare 712. At this time, the suture 705 may be capturedonce by the snare 712.

At this moment, if an operator judges that the suturing operation isfinished at only one planned suture site, the processing goes to a step7. If the puncture position of the suture grasping needle 701 is set asone end of the planned suture site and a plurality of puncture positionsof the suture insertion needle 715 are arranged concentrically aroundthe puncture position of the suture grasping needle 701, the processinggoes to a step 9.

If the number of planned suture site is one and the suturing operationis finished at the one site, then the slide material 713 of the suturetraction tool 710 is allowed to slide upward along the guide material706 of the suture grasping needle 701, and the snare 712 of the suturetraction tool 710 is inserted into the hollow portion 703 through thelateral hole 704 of the suture grasping needle 701 in the step 7 (FIG.13). Accordingly, the snare 712 formed into the annular shape iselastically deformed and gradually linearized, so that the suture 705 isgrasped by the snare 712 in the portion of the lateral hole 704 of thesuture grasping needle 701.

In this state, the edge of the lateral hole 704 is chamfered to have theC-shaped surface or R-shaped surface. Thanks to this, it is possible toprevent the suture 705 from being cut off due to the contact between thesuture 705 grasped by the snare 712 and the lateral hole 704 of thesuture grasping needle 701 by excessively strong force.

In a step 8, the suture grasping needle 701 and the abutment member 722including the suture traction tool 710 are pulled in a direction awayfrom the abdomen of the patient (FIG. 14). Accordingly, the suture 705grasped by the snare 712 of the suture traction tool 710 is pulled outfrom the body. As a result, the suture 705 invades the body from thepuncture position of the suture insertion needle 715, passes into thestomach, and is exposed to the outside of the body from the punctureposition of the suture grasping needle 701.

Thereafter, using a knotter, both ends of the exposed suture are knottedtogether, whereby the stomach wall 101 is fixed to the abdominal wall100 by the suture 705.

Further, if the puncture position of the suture grasping needle 701 isset as one end of the planned suture site and a plurality of puncturepositions of the suture insertion needle 715 are concentrically arrangedaround the puncture position of the suture grasping needle 701, theprocessing goes from the step 5 to the step 9.

In the step 9, the suture 705 is removed from the abutment member 722 bythe notch 723 of the abutment member 722 outside the body while keepinga state in which the suture 705 is passed through the inside of thesnare 712 in the body (FIG. 15). Since the notch 723 is provided in theabutment member 722, it is possible to ensure removing the suture 705from the abutment member 722 while the suture grasping needle 701 isfixed to the abutment member 722.

Then, in a step 10, the abutment member 722 is rotated about thepuncture position of the suture grasping needle 701 in a direction ofthe next planned puncture position of the suture insertion needle 715(FIG. 16). The abutment member 722 can be rotated by 360 degrees.

Next, in a step 11, similarly to the instance in which the suturingoperation is finished at only one planned suture site, the steps 4 to 6in which the suture insertion needle 715 perpendicularly punctures theabdominal wall 100 and the stomach wall 101 of the patient through theabutment member 722 are repeatedly executed by as much as the number oftimes of planned suturing operations.

Finally, in a step 12, similarly to the instance in which the suturingoperation is finished at only one planned suture site, the step 7 inwhich the suture 705 is grasped by the snare 712 in the lateral hole 704of the suture grasping needle 701 and the step 8 are executed.

By doing so, the concentric arrangement of a plurality of puncturepositions of the suture insertion needle 715 around the punctureposition of the puncture needle 701 which is set as one end of theplanned suture site can be realized. The stomach wall 101 is fixed tothe abdominal wall 100 by a plurality of sutures 705.

By rotating the abutment member 722 while the suture grasping needle 701punctures the body, the puncture position of the suture insertion needle715 can be adjusted. It is, therefore, possible to ensure that thestomach wall 101 is fixed to the abdominal wall 100 at a plurality ofpositions on a circular arc about the suture grasping needle 701 by asimple operation.

The procedures for the suturing operation using the medical deviceaccording to this embodiment are thus finished.

In this embodiment, the puncture needles each having the non-hollowsharp tip end are used as the suture grasping needle 701 and the sutureinsertion needle 715, respectively. Due to this, as compared with theuse of the puncture needle having a difference in height such as thehollow needle, the cannula or the outer cylinder, the high punctureperformance is ensured and the living body can be easily punctured.

Further, the single suture grasping needle 701 and the single sutureinsertion needle 715 are operated individually. Due to this, as comparedwith the instance in which the living body is punctured simultaneouslyby the suture grasping needle 701 and the suture insertion needle 715 orthe instance in which the suture grasping needle 701 and the sutureinsertion needle 715 are simultaneously operated, the medical devicedoes not require strong force, experience, and expertise and can lessenthe stress of the patient and shorten operation time.

Furthermore, the puncture position of the suture grasping needle 701 isset as one end of the planned puncture site and a plurality of puncturepositions of the suture insertion needle 715 can be arrangedconcentrically around the puncture position of the suture graspingneedle 705. It is, therefore, possible to safely and surely fix theplanned suture sites. Further, the invasion of the suture into thepatient accompanying this fixing occurs quite infrequently and thepatient is less burdened. It is, therefore, possible to return thepatient to ordinary life at earlier time and to reduce medical cost ofthe patient.

A medical device according to the following embodiment is configured toemploy a suture insertion needle (first puncture needle) 3 and a suturegrasping needle (second puncture needle) 4.

SECOND EMBODIMENT

FIG. 17 is a perspective view that depicts a configuration of a medicaldevice according to the present embodiment.

A medical device 1 shown in FIG. 17 includes a main body 2, a sutureinsertion needle 3 into which a suture can be inserted, and a suturegrasping needle 4 which is provided to be proximate to the sutureinsertion needle 3 and into which a suture traction tool can beinserted. The suture insertion needle 3 and the suture grasping needle 4are detachably attached to the main body 2 by attachment and detachmentmeans.

In this embodiment and a third embodiment, the suture insertion needle 3corresponds to the suture insertion needle 715 (shown in FIG. 1) of themedical device according to the first embodiment. The suture graspingneedle 4 corresponds to the suture grasping needle 701 (shown in FIG. 1)of the medical device according to the first embodiment.

The respective constituent elements of the medical device 1 will bedescribed.

FIG. 18 is a front view that depicts a configuration of the main body 2of the medical device 1. The main body 2 has a function of supportingthe suture insertion needle 3 and the suture grasping needle 4.

The main body 2 has a support member 21, a fixing member 22 provided ona base end of the support member 21 (an upper side thereof in FIG. 17),and an abutment member 23 provided on a tip end thereof (a lower sidethereof in FIG. 17).

In this embodiment and the third embodiment, the abutment member 23corresponds to the abutment member 722 (shown in FIG. 1) of the medicaldevice according to the first embodiment. The fixing member 22corresponds to the fixing member 708 (shown in FIG. 1) of the medicaldevice according to the first embodiment.

The support member 21, which is U-shaped, supports the fixing member 22and the abutment member 23. The suture insertion needle 3 and the suturegrasping needle 4 are supported by the support member 21 through theabutment member 23. Examples of materials for the support member 21include vinyl chloride resin, polycarbonate resin, ABS resin, polyacetalresin, polyamide resin, polypropylene resin, polyethylene resin or thelike, and metal such as stainless steel.

The fixing member 22 includes a function of fixing the suture insertionneedle 3 and the suture grasping needle 4. As shown in FIG. 18, thefixing member 22 includes a first fixing portion 221 and a second fixingportion 222 that fix the suture insertion needle 3 and the suturegrasping needle 4, respectively, and a plate body 223. The first fixingportion 221, the second fixing portion 222, and the plate body 223 areformed integrally.

The first fixing portion 221 and the second fixing portion 222 areprovided on a base end-side surface (an upper side in FIG. 18) of theplate body 223. The first fixing portion 221 and the second fixingportion 222 are provided to be symmetric about the support member 21.

The first fixing portion 221 and the second fixing portion 222 haveabout the same structure and generally rectangular parallelepiped. Thefirst fixing portion 221 is higher than the second fixing portion 222.It is thereby possible for a user to easily visually distinguish thefirst fixing portion 221 from the second fixing portion 222. In thisembodiment, the first fixing portion 221 differs in height from thesecond fixing portion 222. Alternatively, the first fixing portion 221and the second fixing portion 222 may be equal in height.

A first concave portion 224 is provided in the first fixing portion 221into which the suture insertion needle 3 can be inserted.

In the first concave portion 224, a first flange engagement portion 225engageable with a first flange of a first hub 31 (not shown in FIGS. 17and 18), to be described later, provided on the suture insertion needle3 is formed.

The first concave portion 224 is hollowed out cylindrically, smaller indiameter on a tip end and larger on a base end across the first flangeengagement portion 225.

The first concave portion 224 is opened to a front surface side of thefirst fixing portion 221, so that the first hub 31 of the sutureinsertion needle 3, to be described later, can be inserted from thefront surface side thereof.

The first flange (not shown in FIGS. 17 and 18) can be engaged with thefirst flange engagement portion 225. While the first flange (not shownin FIGS. 17 and 18) is engaged with the first flange engagement portion225, the suture insertion needle 3 cannot either rotate or movevertically.

Further, the suture insertion needle 3 can be inserted into the firstconcave portion 224 from the base end side without engaging the firstflange (not shown in FIGS. 17 and 18) with the first flange engagementportion 225. In this case, similarly to the above, an outercircumference of the first flange (not shown in FIGS. 17 and 18) isfitted into the first concave portion 224 and fixed thereto, so that thesuture insertion needle 3 cannot either rotate or move vertically.

The second fixing portion 222 includes a second concave portion 226 intowhich the suture grasping needle 4 can be inserted.

In the second concave portion 226, a second flange engagement portion227 engageable with a second flange of a second hub 41 (not shown inFIGS. 17 and 18), to be described later, provided on the suture graspingneedle 4 is formed.

The second concave portion 226 is hollowed out cylindrically, smaller indiameter on a tip end and larger on a base end across the second flangeengagement portion 227.

The second concave portion 226 is opened to a front surface side of thesecond fixing portion 222, so that the second hub 41 of the suturegrasping needle 4, to be described later, can be inserted from the frontsurface side thereof.

A first notch 2213 and a second notch 2223 are formed in the firstfixing portion 221 and the second fixing portion 222 so that the sutureinsertion needle 3 and the suture grasping needle 4 are detachable,respectively. It is thereby possible to make the suture insertion needle3 and the suture grasping needle 4 detachable, so that operativity canbe improved and it is possible to ensure performing suturing by a simpleoperation.

The first notch 2213 and the second notch 2223 are formed from a frontedge of the fixing member 22 deep into the first concave portion 224 andthe second concave portion 227 through the first fixing portion 221 andthe second fixing portion 222, respectively.

The fixing member 22 includes a slide portion 229 that allows the fixingmember 22 to be slidably moved relative to the support member 21. Thefixing member 22 can be thereby freely moved forward or backwardrelative to the support member 21, thereby facilitating puncturing bythe suture insertion needle 3 and the suture grasping needle 4.

As a material for the fixing member 22, a high transparency syntheticresin material, for example, is preferably used since the fixing member22 is disposed on a site in which a small incision is made in the bodysurface part such as the abdomen with a knife by the method for usingthe medical device to be described later.

The abutment member 23 functions to improve stability when the medicaldevice 1 is used by causing the abutment member 23 to abut on the bodysurface part.

As shown in FIGS. 17 and 18, the abutment member 23 is flat, andincludes a first cylindrical portion 231 that includes an inner cavityinto which the suture insertion needle 3 can be inserted, and a secondcylindrical portion 232 that includes an inner cavity into which thesuture grasping needle 4 can be inserted, on a base end-side surfacethereof.

The first cylindrical portion 231 and the second cylindrical portion 232function to improve stability on the puncture by the suture insertionneedle 3 and the suture grasping needle 4, respectively.

The abutment member 23 includes a first notch 233 and a second notch 234serving as the attachment and detachment means so that the sutureinsertion needle 3 and the suture grasping needle 4 are detachable tothe abutment member 23, respectively. The abutment member 23 can therebydetachably hold the suture insertion needle 3 and the suture graspingneedle 4, thus improving the operativity.

The first notch 233 and the second notch 234 are formed from bottomportions of the abutment member 23 deep into the first cylindricalportion 231 and the second cylindrical portion 232 therethrough,respectively. The suture insertion needle 3 and the suture graspingneedle 4 are thereby made detachable to the abutment member 23.

Further, the abutment member 23 includes two convex portions 235 havinga concave portion at a center thereof into which one end of the supportmember 21 can be inserted. One end of the support member 21 is insertedinto the concave portion of the convex portions 235.

FIG. 19 depicts a front view and a sectional view of the sutureinsertion needle 3. The suture insertion needle 3 functions to insertthe suture into an internal tissue.

As shown in FIG. 19, the suture insertion needle 3 includes the firsthub 31 provided on a base end thereof (upper side in FIG. 19) and afirst needle portion 32 provided on a tip end thereof. The first hub 31and the first needle portion 32 include a hollow portion 33, whichserves as a passage of the suture.

In this embodiment and the third embodiment, the first hub 31corresponds to the stopper 719 (FIG. 3) of the medical device accordingto the first embodiment.

The first hub 31 is generally cylindrical and includes a first flange311 on a tip end side thereof, engageable with the first flangeengagement portion 225. The hollow portion 33 within the first hub 31 isformed so that an inside diameter is gradually smaller from a base endto a tip end.

The first needle portion 32 includes an opening on a tip end thereof(lower side in FIG. 19) to communicate with the hollow portion 33. Thefirst needle portion 32 keeps a constant outside diameter from a baseend near to a tip end and has a sharp needle point formed on the tipend.

In this embodiment and the third embodiment, a shape of the first needleportion 32 can be designed, for example, as that of the suture insertionneedle 715 (FIG. 4) according to the first embodiment. By so designing,in the first needle portion 32, it is possible to ensure that a lateralhole communicating with the outside is oriented to a second needleportion 42. In addition, the suture can be smoothly inserted.

An outside diameter of the first needle portion 32 is not limited to aspecific diameter; however, it can be set, for example, equal to orlarger than 15G and equal to or smaller than 25G, preferably equal to orlarger than 19G and equal toor smaller than 21G. By so setting, it ispossible to reduce a puncture resistance of the suture insertion needle3 and the suture insertion needle 3 can easily puncture the body.

An entire length of the first needle portion 32 is not limited to aspecific length; however, it can be set, for example, equal to or largerthan 20 mm and equal to or smaller than 200 mm, preferably equal to orlarger than 80 mm and equal to or smaller than 100 mm. If the entirelength is too small, the first needle portion 32 may possibly be buriedin the abdominal wall of the patient. If too large, the operativity ofthe medical device may possibly be deteriorated.

FIG. 20 depicts a front view and a sectional view of the suture graspingneedle 4. The suture grasping needle 4 functions to insert the suturetraction tool into the internal tissue. Further, by forming a space intowhich a guide wire can be inserted, in the puncture needle 4, the guidewire as well as the suture can be inserted into the living body. Aposition at which the guidewire is inserted can act as a catheterinsertion position.

As shown in FIG. 20, the suture grasping needle 4 includes the secondhub 41 provided on a base end thereof (upper side in FIG. 20) and thesecond needle portion 42 provided on a tip end thereof. The second hub41 and the second needle portion 42 include a hollow portion 43, whichserves as a passage of the suture traction tool, and further serves as apassage of a guide wire to be described later.

The second hub 41 is generally cylindrical, and includes a second flange411 on a tip end thereof, engageable with the second flange engagementportion 227 and an abutment portion 412 which is provided on a base endthereof and on which a handle portion 51 of the suture traction tool 5abuts. The hollow portion 43 within the second hub 41 is formed so thatan inside diameter is gradually smaller from a base end to a tip end.

A side port 413 into which the guide wire can be inserted is privided ona side portion of the second hub 41. An outside diameter of the guidewire is not limited to a specific diameter; however, it can be set, forexample, equal to or larger than 0.1 mm and equal to or smaller than 0.8mm, preferably equal to or larger than 0.4 mm and equal to or smallerthan 0.6 mm. If the outside diameter is too small, the guide wire isless firm and operativity of the guide-wire may possibly bedeteriorated. If too large, the guidewire may possibly damage the insideof the stomach.

The second needle portion 42 includes an opening on a tip end thereof(lower side in FIG. 20) to communicate with the hollow portion 43.

The second needle portion 42 keeps a constant outside diameter from abase end near to a tip end and has a fine edge formed on the tip end. Ashape of the second needle portion 42 can be designed, for example, asthat of the suture grasping needle 701 according to the first embodiment(shown in FIG. 4). By so designing, in the second needle portion 42, itis possible to ensure that a lateral hole communicating with the outsideis oriented to the first needle portion 32. In addition, it is possibleto allow the suture traction tool and the guide wire to smoothly slidefrom the hollow portion 43 to an outside of the second needle portion42.

An outside diameter of the second needle portion 42 is not limited to aspecific diameter; however, it can be set, for example, equal to orlarger than 12G and equal to or smaller than 22G, preferably equal to orlarger than 16G and equal to or smaller than 18G. By so setting, it ispossible to easily simultaneously insert the suture traction tool andthe guide wire into the suture grasping needle 4, and the guide wire aswell as the suture can easily puncture the body.

An entire length of the second needle portion 42 is not limited to aspecific length; however, it can be set, for example, equal to or largerthan 20 mm and equal to or smaller than 200 mm, preferably equal to orlarger than 80 mm and equal to or smaller than 100 mm. If the entirelength is too small, it may possibly be buried in the abdominal wall ofthe patient. If too large, the operativity of the medical device maypossibly be deteriorated.

FIG. 21 is a front view that depicts a configuration of the suturetraction tool 5. As shown in FIG. 21, the suture traction tool 5includes a rod portion 52, the handle portion 51 provided on a base end(upper side in FIG. 21) of the rod portion 52, and an annular portion 53provided on a tip end thereof. The suture traction tool 5 functions tograsp the suture inserted from the suture insertion needle 3 in theinternal tissue, and to tract the suture up to the body surface part. Itis thereby possible to easily put the body surface portion and theinternal tissue in the suture.

The suture traction tool 5 according to this embodiment and the thirdembodiment corresponds to the suture traction tool 710 (shown in FIG. 1)of the medical device according to the first embodiment. The annularportion 53 corresponds to the snare 712 (shown in FIG. 2 b) of themedical device according to the first embodiment.

The handle portion 51 is generally rectangular parallelepiped and aninside surface thereof is hollowed out generally cylindrically. Thehandle portion 51 is designed to be able to abut on a base end surfaceof the abutment portion 412 of the second hub 41 of the suture graspingneedle 4.

An outside diameter of the rod portion 52 is desired to be smaller thanan inside diameter of the suture grasping needle 4. The outside diameterof the rod portion 52 is not limited to a specific diameter; however, itcan be set, for example, equal to or larger than 0.3 mm and equal to orsmaller than 0.8 mm, more preferably equal to or larger than 0.5 mm andequal to or smaller than 0.6 mm. If the outside diameter is too small,strength of the suture traction tool 5 sometimes cannot be sufficientlysecured. If too large, it is often difficult to insert the guide wire.

A length of the rod portion 52 is not limited to a specific length;however, it can be set, for example, equal to or larger than 45 mm andequal to or smaller than 225 mm, preferably equal to or larger than 105mm and equal to or smaller than 125 mm. If the length is too small, theannular portion 53 may possible not be able to sufficiently protrudefrom the tip end (lower side in FIG. 20) of the needle portion 42 of thesuture grasping needle 4, and the annular portion 53 often may possiblenot be able to grasp the suture. If too large, the suture pulled outfrom the tip end (lower side in FIG. 19) of the first needle portion 32of the suture insertion needle 3 may possibly not be able to be surelyinserted into the annular portion 53 of the suture traction tool 5.

The operativity of the suture grasping needle 4 when the suture tractiontool 5 and the guide wire are simultaneously inserted into the suturegrasping needle 4 depends on a clearance (a gap distance) between theoutside diameter of the rod portion 52 or that of the guide wire and theinside diameter of the suture grasping needle 4. The combination of theinside diameter of the suture grasping needle 4, and the outsidediameter of the rod portion 52 of the suture traction tool 5, and theoutside diameter of the guide wire can be set so that the clearance is,for example, equal to or larger than 0.05 mm and equal to or smallerthan 0.30 mm. By doing so, the operativity can be surely improved.

The annular portion 53 is deformed and substantially linearized withinthe suture grasping needle 4, and annular when protruding from thesuture grasping needle 4. This can facilitate grasping the suture. Amaterial for the annular portion 53 is, therefore, preferably an elasticmaterial as will be described later.

As shown in FIGS. 17 and 21, the medical device is formed so that acentral axis of the suture insertion needle 3 or an extension thereofpenetrates the inside of the annular portion 53 when the annular portion53 protrudes from the suture grasping needle 4. It is thereby possibleto ensure grasping the suture.

A diameter of the annular portion 53 is not limited to a specificdiameter; however, it can be set, for example, equal to or larger than1.5 L and equal to or smaller than 3.0 L (mm) if the distance betweenthe suture insertion needle 3 and the suture grasping needle 4 is L(mm). By so setting, it is possible to further ensure grasping thesuture.

A line diameter of the annular portion 53 is not limited to a specificone; however, it can be set, for example, equal to or larger than 0.1 mmand equal to or smaller than 0.3 mm, preferably equal to or larger than0.14 mm and equal to or smaller than 0.24 mm. If the line diameter istoo small, it is sometimes difficult for the annular portion 53 to bedeformed into a linear state and an annular state when a high viscositybody fluid adheres to the annular portion 53. If the line diameter istoo large, the suture traction tool 5 and the guide wire may possiblynot be able to be simultaneously inserted into the suture graspingneedle 4.

One example of a method for using the medical device 1 will be describedwith reference to FIGS. 22 to 31. FIGS. 22 to 31 are sectional frontviews for describing the method for using the medical device 1. Themedical device 1 can be used according to the following procedures [1]to [11].

[1] Before use of the medical device 1, the endoscope is inserted intothe stomach of the patient to sufficiently supply the air thereto, andthe abdominal wall 100 is closely attached to the stomach wall 101.Next, a position of the stomach is confirmed by a transparent light fromthe endoscope, and the abdominal skin is disinfected and anesthetizedlocally. A small incision is made in the position of the stomach by theknife.

[2] The abutment member 23 of the main body 2 abuts on the abdominalwall 100, and the suture grasping needle 4 punctures the abdominal wall100 and the stomach wall 101 of the patient substantiallyperpendicularly from the small-incision site (FIG. 22).

[3] The handle portion 51 of the suture traction tool 5 is operated andthe suture traction tool 5 is inserted into the hollow portion 43 of thesuture grasping needle 4 until a lower end of the handle portion 51abuts on the second hub 41. The annular portion 53 of the suturetraction tool 5 thereby protrudes from the tip end of the suturegrasping needle 4 and spreads annually (FIG. 23). To insert the suturetraction tool 5 into the suture grasping needle 4, the suture tractiontool 5 may be stored in the suture grasping needle 4 in advance beforeperforming the operation described in paragraph [2].

[4] The suture insertion needle 3 punctures the abdominal wall and thestomach wall of the patient through the fixing member 22 and theabutment member 23 substantially perpendicularly. At this time, thesuture insertion needle 3 is set to pass through the inside of theannular portion 53 of the suture traction tool 5 (FIG. 24).

In the using method according to this embodiment, it is unnecessary forthe suture insertion needle 3 and the suture grasping needle 4 tosimultaneously puncture. Since the respective puncture needle canpuncture them separately, the puncture operation is easier than thatwhen the two puncture needles are used to puncture the targetssimultaneously.

[5] The suture 102 is inserted into the hollow portion 33 of the sutureinsertion needle 3 to protrude the suture 102 from the tip end of thesuture insertion needle 3 (FIG. 25). At this time, the suture insertionneedle 3 is passed through the inside of the annular portion 53, so thatthe suture 102 also is passed through the inside of the annular portion53.

[6] While the main body 2 and the suture grasping needle 4 are kept asthey are, only the suture insertion needle 3 is pulled out from thefixing member 22 to the base end side (upper side in FIG. 26) (FIG. 26).At this time, a protruding portion of the suture 102 can be set long. Bydoing so, it is possible to prevent the suture 102 from being pulledout. In addition, the suture insertion needle 3 can be pulled out whilesupplying the suture 102 thereto. As a result, the suture 102 is passedthrough the inside of the annular portion 53. At this moment, bywithdrawing the suture traction tool 5, it is possible to confirm thatthe suture 102 is grasped.

[7] The main body 2 is rotated around the suture grasping puncture tool4, as a rotational axis, substantially by 180 degrees (FIG. 27). Bydoing so, the suture 102 is passed through the first notch 2223 of thefixing member 22 and is detached from the fixing member 22 and theabutment member 23. Care should be taken not to pull out the suture 102from the inside of the annular portion 53.

[8] After rotation, the suture insertion needle 3 punctures theabdominal wall and the stomach wall of the patient again through thefixing member 22 and the abutment member 23 substantiallyperpendicularly. At this time, similarly to the operation shown in FIG.25, the suture insertion needle 3 is set to pass through the inside ofthe annular portion 53 of the suture traction tool 5. The suture 102 isinserted into the hollow portion 33 of the suture insertion needle 3 toprotrude the suture 102 from the tip end of the suture insertion needle3 (FIG. 28). As a result, the two sutures 102 are arranged inside theannular portion 53.

[9] The suture traction tool 5 is slightly raised upward. At thismoment, since the two sutures 102 are arranged inside the annularportion 53, the annular portion 53 enters the inner cavity of the suturegrasping needle 4 and the two sutures 102 are grasped by withdrawing thesuture traction tool 5 (FIG. 29).

[10] The guide wire 103 is inserted into the suture grasping needle 4from the side port 413 of the hub 41 thereof (FIG. 30). The guide wireinsertion operation may be performed at arbitrary time as long as theoperation is performed after the suture grasping needle 4 punctures theabdominal wall and the stomach wall.

[11] The two sutures 102 are grasped by the suture traction tool 5, andthe main body 2 is pulled out from the abdominal wall 100 while thesuture insertion needle 3 is attached to the main body 2. Through theseoperations, the sutures 102 inserted from the two puncture positions atwhich the suture insertion needle 3 is inserted are passed from theabdominal wall 100 into the stomach wall 101 and protrudes from thepuncture position of the suture grasping needle 4 (FIG. 31). Further, atthe puncture position of the suture grasping needle 4, the guide wire103 is inserted. Ends of the respective sutures 102 are knotted to fixthe abdominal wall 100 to the stomach wall 101.

As can be understood, the medical device 1 is configured so that thesuture insertion needle 3 and the suture grasping needle 4 aredetachable from the main body 2. By using these puncture needles 3 and4, it is possible to ensure putting the abdominal wall 100 to thestomach wall 101 in the two sutures 102 by the simple operation.

In this embodiment, the instance in which the suture insertion needle 3and the suture grasping needle 4 puncture separately has been described.However, the method for using the medical device 1 is not limited to theinstance. The puncture needles can simultaneously puncture them. To doso, the first flange 311 of the suture insertion needle 3 is engagedwith the first flange engagement portion 225 of the first fixing portion221, and the second flange 411 of the suture grasping needle 4 isengaged with the second flange engagement portion 227 of the secondfixing portion 222.

THIRD EMBODIMENT

The medical device according to the first or second embodiment caninclude a plurality of suture insertion needles. An instance in whichthe medical device according to the second embodiment includes twopuncture needles will be described.

FIG. 32 is a perspective view that depicts a configuration of a medicaldevice 11 according to the present embodiment. As shown in FIG. 32, themedical device 11 includes a main body 2, a suture insertion needle 3and a suture insertion needle (third puncture needle) 6, which aresupported by the main body 2 and into which a suture can be inserted,and a suture grasping needle 4 which is provided to be proximate to thesuture insertion needles 3 and 6 and into which a suture traction toolcan be inserted. The suture insertion needles 3 and 6 and the suturegrasping needle 4 are detachably attached to the main body 2 byattachment and detachment means.

This medical device 11 is configured so that the suture insertion needle6 is also detachably attached to the main body 2 of the medical device 1(FIG. 17) according to the second embodiment. The other constituentelements can be applied to those of, for example, the medical device 1.

The respective constituent elements of the medical device 11 will bedescribed, while centering around differences from the medical device 1according to the second embodiment.

FIG. 33 is a front view that depicts a configuration of the main body 2of the medical device 11. The main body 2 has a function of supportingthe suture insertion needle 3, the suture grasping needle 4, and thesuture insertion needle 6.

The main body 2 includes a support member 21, a fixing member 22provided on a base end of the support member 21 (an upper side thereofin FIG. 33), and an abutment member 23 provided on a tip end thereof (alower side thereof in FIG. 33).

The fixing member 22 has a function of fixing the suture insertionneedle 3, the suture grasping needle 4, and the suture insertion needle6.

As shown in FIG. 33, the fixing member 22 includes a first fixingportion 221, a second fixing portion 222, and a third fixing portion2231 that fix the suture insertion needle 3, the suture grasping needle4, and the suture insertion needle 6, respectively, and a plate body223. The first fixing portion 221, the second fixing portion 222, thethird fixing portion 2231, and the plate body 223 are formed integrally.

The first fixing portion 221, the second fixing portion 222, and thethird fixing portion 2231 are provided in a substantially linear manneron a base end-side surface (upper side in FIG. 33) of the plate body223.

The first fixing portion 221, the second fixing portion 222, and thethird fixing portion 2231 are substantially equal in structure andgenerally rectangular parallelepiped. The first fixing portion 221 andthe third fixing portion 2231 are higher than the second fixing portion222. It is thereby possible for a user to easily visually distinguishthe respective fixing portions. In this embodiment, the first fixingportion 221 and the third fixing portion 2231 differ in height from thesecond fixing portion 222. Alternatively, the first fixing portion 221,the third fixing portion 2231, and the second fixing portion 222 may beequal in height.

The third fixing portion 2231 includes a third concave portion 2234 intowhich the suture insertion needle 6 can be inserted.

In the third concave portion 2234, a third flange engagement portion2232 engageable with a third flange of a third hub 61 (not shown inFIGS. 32 and 33), to be described later, provided on the sutureinsertion needle 6 is formed.

The third concave portion 2234 is hollowed out cylindrically, smaller indiameter on a tip end and larger on a base end across the third flangeengagement portion 2232. The third concave portion 2234 is opened to afront surface side of the third fixing portion 2231, so that the thirdhub 61 of the suture insertion needle 6, to be described later, can beinserted from the front surface side thereof.

The third flange 611, to be described later with reference to FIG. 34,can be engaged with the third flange engagement portion 2232. While thethird flange 611 is engaged with the third flange engagement portion2232, the suture insertion needle 6 cannot either rotate or movevertically.

Further, the suture insertion needle 6 can be inserted into the thirdconcave portion 2234 from the base end side without engaging the thirdflange 611 with the third flange engagement portion 2232. In this case,similarly to the above, an outer circumference of the third flange 611is fitted into the third concave portion 2234 and restricted thereby, sothat the suture insertion needle 6 cannot either rotate or movevertically.

A third notch 2233 is formed in the third fixing portion 2231 so thatthe suture insertion needle 6 is detachable. It is thereby possible tomake the suture insertion needle 6 detachable, so that operativity canbe improved. The third notch 2233 is formed from a front-side bottom ofthe fixing member 22 deep into the third concave portion 2234 throughthe third fixing portion 2231.

As shown in FIGS. 32 and 33, the abutment member 23 is flat, andincludes a first cylindrical portion 231 that includes an inner cavityinto which the suture insertion needle 3 can be inserted, a secondcylindrical portion 232 that includes an inner cavity into which thesuture grasping needle 4 can be inserted, and a third cylindricalportion 2335 that includes an inner cavity into which the sutureinsertion needle 6 can be inserted, on a base end-side surface thereof.The abutment member 23 functions to improve stability when the medicaldevice 11 is used by causing the abutment member 23 to abut on the bodysurface part.

The first cylindrical portion 231, the second cylindrical portion 232,and the third cylindrical portion 2335 function to improve stabilitywhen the suture insertion needle 3, the suture grasping needle 4, andthe suture insertion needle 6 puncture, respectively.

The abutment member 23 includes a first notch 233, a second notch 234,and a third notch 236 serving as the attachment and detachment means sothat the suture insertion needle 3, the suture grasping needle 4, andthe suture insertion needle 6 are detachable to the abutment member 23,respectively. The suture insertion needle 3, the suture grasping needle4, and the suture insertion needle 6 can thereby be detachably hold,thus improving the operativity.

The first notch 233, the second notch 234, and the third notch 236 areformed from bottom portions of the abutment member 23 deep into thefirst cylindrical portion 231, the second cylindrical portion 232, andthe third cylindrical portion 2335 therethrough, respectively. Thesuture insertion needle 3, the suture grasping needle 4, and sutureinsertion needle 6 are thereby made detachable to the abutment member23.

FIG. 34 depicts a front view and a sectional view of the sutureinsertion needle 6. As shown in FIG. 34, the suture insertion needle 6includes the third hub 61 provided on a base end thereof (upper side inFIG. 34) and a third needle portion 62 provided on a tip end thereof.The suture insertion needle 6 functions to insert the suture into aninternal tissue, similarly to the suture insertion needle 3.

The third hub 61 and the third needle portion 62 include a hollowportion 63, which serves as a passage of the suture. The hollow portion63 within the third hub 61 is formed so that the inside diameter isgradually smaller from a base end to a tip end.

In this embodiment, the third hub 61 corresponds to the stopper 719(FIG. 3) of the medical device according to the first embodiment.

The third hub 61 is generally cylindrical and includes a third flange611 engageable with the third flange engagement portion 2232 on a tipend thereof.

The third needle portion 62 includes an opening on a tip end thereof(lower side in FIG. 34) to communicate with the hollow portion 63. Thethird needle portion 62 keeps a constant outside diameter from a baseend near to a tip end and has a sharp needle point formed on the tipend.

The configuration of the first needle portion 32 can be applied to thatof the third needle portion 62. A shape of the third needle portion 62can be designed equally to, for example, that of the suture insertionneedle 715 (FIG. 4) according to the first embodiment. By so designing,in the third needle portion 62, it is possible to ensure that a lateralhole communicating with the outside is oriented to the second needleportion 42. In addition, the suture can be smoothly inserted into thehollow portion 63.

An outside diameter of the third needle portion 62 is not limited to aspecific diameter; however, it can be set, for example, equal to orlarger than 15G and equal to or smaller than 25G, preferably equal to orlarger than 19G and equal to or smaller than 21G. By so setting, it ispossible to reduce a puncture resistance of the suture insertion needle6 and the suture insertion needle 6 can easily puncture the body.

An entire length of the third needle portion 62 is not limited to aspecific length; however, it can be set, for example, equal to or largerthan 20 mm and equal to or smaller than 200 mm, preferably equal to orlarger than 80 mm and equal to or smaller than 100 mm. If the entirelength is too small, it may possibly be buried in the abdominal wall ofthe patient. If too large, the operativity of the medical device 11 maypossibly be deteriorated.

Another example of the method for using the medical device 11 will bedescribed. As stated above, the respective constituent elements of themedical device 1 are basically applied to the medical device 11, and themedical device 11 is configured so that the suture insertion needle 6can be further detachably provided on the main body 2 of the medicaldevice 1. When using the medical device 11, therefore, the proceduresfor using the medical device 1 can be adopted. Differences from theprocedures described in the paragraphs [1] to [11] will be mainlydescribed hereafter.

[12] The operations described from [1] to [5] by the medical device 1are similarly carried out.

[13] While the main body 2, the suture insertion needle 3, and thesuture grasping needle 4 are kept as they are, the handle portion 51 ofthe suture traction tool 5 is operated to rotate the suture tractiontool 5 by 180 degrees. Care should be taken not to pull out the suture102 from the inside of the annular portion 53. At this moment, aprotrusion of the suture 102 can be made long so as not to pull out thesuture 102.

[14] The suture insertion needle 6 punctures the abdominal wall and thestomach wall of the patient through the fixing member 22 and theabutment member 23 substantially perpendicularly. At this time,similarly to the operation shown in FIG. 25, the suture insertion needle6 is set to pass through the inside of the annular portion 53 of thesuture traction tool 5. Then the suture 102 is inserted into the hollowportion 63 of the suture insertion needle 6 to protrude the suture 102from the tip end of the suture insertion needle 6. As a result, the twosutures 102 are arranged inside the annular portion 53.

In this using method, it is unnecessary for the suture insertion needle3, the suture grasping needle 4, and the suture insertion needle 6 topuncture simultaneously. Namely, the respective puncture needles canpuncture them separately, so that puncture operation can be performedeasily as compared with the instance in which the two puncture needlespuncture simultaneously.

[15] The suture traction tool 5 is slightly raised upward. At thismoment, since the two sutures 102 are arranged inside the annularportion 53, the annular portion 53 enters the inner cavity of the suturegrasping needle 4 and the two sutures 102 are grasped by withdrawing thesuture traction tool 5.

[16] The guide wire 103 is inserted into the suture grasping needle 4from the side port 413 of the hub 41 thereof. The guide wire insertionoperation may be performed at arbitrary time as long as the operation isperformed after the suture grasping needle 4 punctures.

[17] The main body 2 is pulled out from the abdominal wall 100 while thetwo sutures 102 are grasped by the suture traction tool 5 and the sutureinsertion needles 3 and 6 are attached to the main body 2. Through theseoperations, the sutures 102 inserted from the two puncture positions atwhich the suture insertion needles 3 and 6 are inserted are passed fromthe abdominal wall 100 into the stomach wall 101 and protrudes from thepuncture position of the suture grasping needle 4. Further, at thepuncture position of the suture grasping needle 4, the guide wire 103 isinserted. Ends of the respective sutures 102 are knotted to fix theabdominal wall 100 to the stomach wall 101.

As can be understood, by using the medical device 11, it is possible tofurther ensure putting the abdominal wall 100 to the stomach wall 101 inthe two sutures 102.

The medical device according to the present invention has been describedso far with reference to the embodiments. However, the present inventionis not limited to the embodiments.

For example, the shapes of the support member, the fixing member, theabutment member, and so forth. of the main body, the structure of theattachment and detachment means, the shapes of the hubs of therespective puncture needles, or the like. may differ from thoseaccording to the embodiments. Specifically, a hole into which the guidewire 103 can be inserted may be provided on the upper surface of thehandle portion 51. If this hole communicates with the hollow portion 43in the second hub 41, the suture traction tool 5 and the guide wire 103can be easily inserted into the suture grasping needle 4 simultaneously.The hole into which the guide wire 103 can be inserted and which isformed in the handle portion 51 may be formed in an arbitrary portion ofthe handle portion 51.

Further, the suture grasping needle 4 or 701 may include two or morelumens. If so, the simultaneous insertion of the suture traction tool 5and the guide wire 103 into the suture grasping needle 4 can be easilyperformed.

Moreover, the target sites of the living body are not limited to theabdominal wall and the stomach wall. The present invention is alsoapplicable to lifting or the like of various visceral walls, bloodvessels, nerves, and the like. to the abdominal wall.

1. A medical device comprising: (a) a suture insertion needle that is ahollow puncture needle including a sharp tip end, said tip end beingnon-hollow, that includes a lateral hole near said tip end, and that isused by inserting a suture into a hollow portion of said sutureinsertion needle; (b) a suture grasping needle that is a hollow punctureneedle arranged sideways of said suture insertion needle substantiallyin parallel to said suture insertion needle and including a sharp tipend, said tip end being non-hollow, that includes a lateral hole nearthe tip end, and that is used by inserting said suture into a hollowportion of said suture grasping needle; (c) a suture traction toolslidably inserted into said hollow portion of said suture graspingneedle; (d) a fixing member for relatively determining a tip endposition of said suture insertion needle and a tip end position of saidsuture grasping needle; and (e) an abutment member that supports saidsuture insertion needle and said suture grasping needle, and that abutson a suture target.
 2. The medical device according to claim 1, whereinsaid suture traction tool includes a snare having a tip end formed outof an elastically deformable material, which extends so that anextension of said suture insertion needle passes through an inside ofsaid snare in a free state, and can be stored in said hollow portion ofsaid suture grasping needle in an elastically deformed state.
 3. Themedical device according to claim 1, wherein said abutment membersupports said suture insertion needle and said suture grasping needlesubstantially parallel to each other.
 4. The medical device according toclaim 1, wherein said fixing member is provided at said suture graspingneedle, and configured to be able to determine the tip end position ofsaid suture insertion needle relative to the tip end position of saidsuture grasping needle, to an arbitrary position.
 5. The medical deviceaccording to claim 1, wherein a notch configured to remove said suturefrom said fixing member is provided at each of said abutment member andsaid fixing member.
 6. The medical device according to claim 1, whereinan edge of said lateral hole of said suture insertion needle and an edgeof said lateral hole of said suture grasping needle are chamfered tohave a C-shaped surface or an R-shaped surface.
 7. The medical deviceaccording to claim 1, wherein at least one of said suture insertionneedle and said suture grasping needle is detachably supported by saidabutment member.
 8. The medical device according to claim 1, furthercomprising a plurality of said suture insertion needles, wherein saidsuture grasping needle is provided to be proximate to each of saidplurality of said suture insertion needles.
 9. A medical device used toput a body surface part and an internal tissue in a suture, comprising:a main body; a suture insertion needle which is supported by said mainbody, and into which the suture can be inserted; and a suture graspingneedle which is provided to be proximate to said suture insertionneedle, and into which a suture traction tool can be inserted, whereinsaid suture grasping needle includes a sharp tip end and an openingprovided in proximity to a base end side relative to said tip end, andis configured so that said suture traction tool can be withdrawn fromsaid opening to an outside of said suture grasping needle.
 10. A medicaldevice used to put a body surface part and an internal tissue in asuture, comprising: a main body; a suture insertion needle which issupported by said main body, and into which the suture can be inserted;and a suture grasping needle which is provided to be proximate to saidsuture insertion needle, and into which a suture traction tool can beinserted, wherein at least one of said suture insertion needle and saidsuture grasping needle is detachably attached to said main body.
 11. Themedical device according to claim 10, wherein said main body includes: afixing member that fixes one of a tip end of said suture insertionneedle and a tip end of said suture grasping needle to a predeterminedposition; and a support member that supports said fixing member.
 12. Themedical device according to claim 11, wherein said main body furtherincludes an abutment member that is provided on a tip end side of saidsupport member, that abuts on said body surface part, and that supportssaid suture insertion needle and said suture grasping needle.
 13. Themedical device according to claim 10, wherein said suture graspingneedle is configured so that a guide wire can be also inserted into saidsuture grasping needle.
 14. The medical device according to claim 13,wherein an outside diameter of said guide wire is equal to or largerthan 0.1 mm and equal to or smaller than 0.8 mm.
 15. The medical deviceaccording to claim 11, wherein said fixing member includes a notch thatmakes one of said suture insertion needle and said suture graspingneedle detachable from said main body.
 16. The medical device accordingto claim 12, wherein said abutment member includes a notch that makesone of said suture insertion needle and said suture grasping needledetachable from said main body.
 17. The medical device according toclaim 10, wherein said suture insertion needle and said suture graspingneedle are configured to be able to puncture independently of eachother.
 18. The medical device according to claim 10, wherein while saidsuture insertion needle and said suture grasping needle puncture andsaid main body abuts on said body surface part, said suture insertionneedle can be independently removed.
 19. The medical device according toclaim 10, wherein said main body is rotatable about said suture graspingneedle used as a rotational axis.
 20. The medical device according toclaim 10, further comprising a plurality of said suture insertionneedles, wherein said suture grasping needle is provided to be proximateto each of the plurality of suture insertion needles.